L to r, MTA drivers Dawn White, Luis Martinez and Jim Criss; DCI patient Darren Jackson; dietitian Sharon Stewart and interim nurse manager Adriana Murray. Photo credit: Suzanne Pletcher
By Sunday afternoon, the second day of the power outage in Ukiah, Darren Jackson was getting worried.
Pacific Gas & Electric had cut power, and no one knew when it would be restored. Jackson was scheduled for dialysis treatment at Dialysis Clinic Inc. in Ukiah on Monday. Already he was feeling that subtle, familiar tiredness that crept up on him toward the end of the weekend as toxins began to permeate his blood.
Jackson worried because he knew the clinic had no back-up power. That information was in an emergency packet he’d been given by DCI in July. In case of a Public Safety Power Shutoff, it read, DCI-Ukiah has no back-up power and you may need to be dialyzed somewhere else. There was a hotline to corporate DCI offices in Nashville, Tenn., for instructions on where to go for dialysis, and a list of regional clinics was provided.
But Jackson lived alone and relied on public transportation: He had no way to get to a clinic outside of Ukiah for his regular Monday, Wednesday and Friday treatments.
“Everyone is different in terms of how often they need dialysis: It depends upon how much kidney function remains,” said Sharon Stewart, a dietitian at DCI. “Most people can go a week, but with each passing day life is deteriorating as the body slowly fills with fluids and toxins.”
On Sunday, Stewart called DCI’s interim nurse manager, Adriana Murray, to check in. Murray was at the clinic, sorting through patient files to determine the treatment needs of 43 patients who would normally be dialyzed on Monday. She told Stewart that lights and heat were off at the clinic, and—even more concerning—the phones. Patients would have to call the hotline at the clinic’s corporate emergency command center to reach caregivers. So Murray was proactive: She called critical patients on her cellphone and advised those she reached to get to the DCI Fort Bragg clinic for their Monday treatment.
Jackson wasn’t on the critical list.
Though he didn’t hear from DCI on Sunday, Jackson didn’t really expect to. Knowing his dialysis might be delayed, he followed instructions in his emergency information packet to cut fluid intake to no more than two cups a day and avoid salt.
Before kidney failure, Jackson was a former program director of the Ukiah Boys and Girls Club and a foster parent with Redwood Children’s Services.
“I really enjoyed that career until I was diagnosed with hypertension,” the lanky Jackson said. “I am much more comfortable being a caregiver than taking care of myself.” He tried to ignore the possible consequences of not adequately managing the disease.
“Even when I was working I couldn’t afford the medication I needed. I didn’t have insurance that would support that,” he said softly.
But after nine years of regular dialysis at DCI, Jackson had a manageable routine. Now he sat in his silent apartment and fretted because the PSPS had changed that.
On Monday, Stewart awoke to a cold house with no working stove. The DCI-Ukiah clinic was closed due to the PSPS, but she went to work to see if she could be useful. There, she joined Murray and other staff who were using flashlights to pull patient files. They called patients using their cell phones to advise them of other clinics that could treat them during the outage.
“I remember there were pieces of paper all over,” said Stewart.
About 73 patients were going to need care in just the next day or two. DCI’s Fort Bragg clinic had backup power, but it was small, with only 10 chairs compared to DCI-Ukiah’s 24. That clinic scheduled extra patients at the end of Monday, but the Ukiah patients would have to get there.
DCI-Ukiah had been working on PSPS preparedness since a spring, 2019, prep meeting to coordinate county social services, schools, health care providers, waste management and public transportation. The DCI-Ukiah rep at the meeting had pointed out that 114 people from throughout Mendocino County require dialysis an average three times a week, most of them at the DCI-Ukiah clinic.
After the meeting, DCI staff began preparing. They got a bid for a backup generator large enough to power the clinic during a PSPS and prioritized patients into groups based upon critical need for dialysis.
Now on Monday and into the third day without power, DCI staff called patients, but some people’s phones weren’t working.
“We had to call the sheriff to go and a do welfare checks on four patients that we couldn’t reach,” said Stewart.
Jackson got his first call from DCI on Monday morning.
They would not be open for his regular appointment, he said they told him: Follow the packet instructions, and we will call you as soon as we can schedule you for treatment.
By then, Jackson’s two-week supply of meat had defrosted in the freezer, and he was afraid to eat any more of it. Protein is a staple food for dialysis patients, and Jackson was stressed about the financial loss of the spoiled meat. He had canned soups to eat but they contained a lot of sodium. He tried not to eat much of it and waited for the next call.
DCI opened its Fort Bragg clinic on Tuesday, a day when that clinic is usually closed. In order to fit every one of the patients in for treatment, treatment times would be reduced to two hours each.
But many DCI patients are like Jackson and don’t drive, relying instead upon Mendocino Transit Authority for public bus transportation.
As the nation’s largest non-profit dialysis provider, DCI’s internal emergency plan calls for contracting with transportation companies to get patients to other clinics in case of a power outage. But Stewart had attended the spring OES prep meeting and knew that MTA buses were available for emergency transportation.
Stewart called MTA. “This is an emergency, we need a charter bus,” she said.
MTA Operations Manager Jacob King also had attended the spring PSPS preparedness meeting.
“I remember hearing at the meeting the number of dialysis patients and knew that would be a transportation issue,” he said. “So when I got the call, I took this extremely seriously.”
He told DCI’s Stewart to contact Megan Schlichter at the local Office of Emergency Services to activate emergency services and gave her the phone number. Within minutes, he got the go-ahead call from OES.
Stewart and King planned for a Tuesday 6:00 a.m. bus to depart DCI Ukiah for Fort Bragg with prioritized patients aboard. MTA Operations Supervisor Luis Martinez would drive, wait for his passengers to finish dialysis, then bring them back. Driver Josh Eaton would drive the next bus to Fort Bragg at 9:30 a.m.
“It was like doing a Rubik cube in the dark,” said King. Each bus can take only two wheelchairs, so we were trying to figure out which folks would go on each bus.”
By late afternoon Monday, Jackson still hadn’t heard from DCI, and he wanted dialysis.
He called Ukiah Valley Hospital and let them know he needed dialysis. But he couldn’t go there, he was told, unless it was an emergency.
Jackson knew it wasn’t an emergency yet, so he sat back down, monitored himself, drank little, ate almost nothing, and waited through the night.
“I’m not really focused by then and thinking straight. It was the not knowing when I’d get treatment that was stressful. There was a whole slew of things physical and emotional that I went through,” he said.
MTA had an OES emergency plan.
General Manager Carla Meyer brought expertise in emergency use of public transit to MTA when she took the job in 2016. She had served earlier as the transit agency representative to OES planning meetings in Washington state. When a large senior housing complex there caught fire one mid-winter night, the agency that Meyer managed deployed buses and drivers to transport frail, stressed seniors to the Red Cross center.
“In emergencies, people can run around willy-nilly. You have to have one agency—the local OES—that coordinates efforts; that’s their job and expertise. Because MTA takes federal dollars, we are required to be available to local and state emergency services for evacuation or any need they may have.” said Meyer. “But MTA is not going ahead until I get OES’ green light. Then they know what is going on so that when they receive frantic calls they know it is handled.”
In 2017 in Ukiah, she gave OES a 24-hour on-call MTA phone number to call in emergencies. MTA developed an internal plan. The first test was the Redwood Complex fire. MTA parked a lift-equipped bus on emergency evacuation standby at Howard Memorial Hospital in Willits for four days as wildfire raged on Pine Mountain nearby.
Now early Tuesday on the fourth day of the outage, with a green light from DCI for bus transfer of patients and an OES emergency order for service, MTA’s King followed Martinez’s early bus over to DCI and helped load passengers and dialysis supplies for a 6:00 a.m. departure. He fetched blankets for some patients and assured everyone they were in good hands for the drive.
When MTA’s Martinez unloaded patients in Fort Bragg, he learned that the power was not going to come back on that day. More buses were needed to transport up to 73 patients. Martinez would bring back the early bus to DCI, drop off patients, swap out the bus at MTA’s yard for another with a full tank of gas, then load more patients at DCI for a 12:30 p.m. drive back to Fort Bragg. A fourth bus driven by Mobility Manager Dawn White would drive patients to Santa Rosa. Finally, a 3:30 p.m. bus would take the last load of patients to Fort Bragg.
“In the beginning, it was like every time we turned around we needed more buses, more drivers, and that’s where our team did an amazing job,” said King. After driving 497 miles in 17 hours, the last of the MTA emergency service buses returned to Ukiah with dialyzed patients at 11 p.m. Tuesday night. Rather than drop his few patients off at DCI, MTA driver Jim Criss took them home.
Jackson was not on the 6 a.m. bus or the next one at 9:30 a.m.
“I was at the point where I would dialyze anywhere. My body was sending messages: ‘You need to dialyze now,’” he said.
Then Jackson’s phone rang and DCI’s Stewart asked if he could get to the Ukiah clinic in time to catch a 3:30 p.m. bus to Fort Bragg. A friend gave him a ride to the clinic and he made the trip.
The lights came back on Wednesday. Jackson went in to DCI-Ukiah on Thursday for a full dialysis treatment. By Friday, the crisis was over. Murray, Stewart, King, Meyer and the whole community breathed a sigh of relief.
Meyer said, “What I really want the public to know is that MTA is ready for emergencies. We have the people, we have the equipment that is all ramp and wheelchair accessible, we have professionally trained drivers who know how to handle frail people with disabilities. My message to city and county emergency services is, we’re here, we’re ready for you. Use us.”
DCI corporate stated, “DCI greatly appreciates MTA’s work with DCI during the recent power outage to ensure Ukiah dialysis patients received the life-sustaining care they needed.”